If you’ve done benefits investigations, prior auths, or lived in the insurance phone tree trenches, this role is for you. You’ll be the person who keeps the reimbursement process moving, documents everything cleanly, and helps providers and patients get to “approved.”
About CareMetx
CareMetx supports the patient journey with hub services, tech, and decision-making data for pharmaceutical, biotech, and medical device organizations. They help patients access specialty products and services by managing reimbursement, exploring alternative funding when needed, and supporting the overall process from intake to outcomes.
Schedule
- Remote
- Flexible schedule and hours required
- Overtime may be required at times
- Must be willing to work weekends if needed to meet business demands
What You’ll Do
- Collect and review patient insurance benefits (as authorized by program SOPs)
- Assist physician offices and patients with insurance forms and program applications
- Complete and submit prior authorization paperwork to third-party payers, track status, and follow up
- Provide strong customer service, resolve requests accurately, and escalate issues/complaints appropriately
- Maintain frequent phone contact with provider offices, payer reps, and pharmacy staff
- Document provider, payer, and client interactions in the CareMetx Connect system
- Identify reimbursement trends or delays and report them to your supervisor
- Process insurance and patient correspondence as needed
- Gather and provide required PA documentation (demographics, referrals/authorizations, NPI, referring MD info, etc.)
- Coordinate with internal teams to keep cases moving
- Communicate with payers to ensure accurate and timely benefit investigations
- Report Adverse Events (AEs) disclosed, following training and SOP requirements
- Handle moderate-scope problems using defined procedures and good judgment
- Take on other duties as assigned (expect change as programs evolve)
What You Need
- High school diploma or GED
- 1+ year experience in specialty pharmacy, medical insurance, physician office, healthcare setting, or related role
- Strong written and verbal communication skills
- Ability to build productive relationships internally and externally
- Strong interpersonal and negotiating skills
- Organized, detail-oriented, and able to manage time well
- Working knowledge of pharmacy and medical benefits (commercial and government payers preferred)
- Proficiency with Microsoft Excel, Outlook, and Word
- Comfortable working independently and as part of a team
- Solid problem-solving skills
- Customer-satisfaction mindset
Benefits
- Not listed in the posting (so assume standard package may exist, but don’t count on specifics until confirmed)
Compensation
- $30,490.45 – $38,960.02 per year
This one’s a good fit if you can juggle multiple cases, stay calm on payer calls, and treat documentation like it’s the job (because it is).
Happy Hunting,
~Two Chicks…